HomeMy WebLinkAbout0025 BROOKS ROAD - HAZMAT o�5 Broo1Cs nis
'� 3g - VY1
:OWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
} OWNER AND INSTALLER INFORMATION
ADDRESS: F . '� 1 �-- `�.-`I�»,�� MAP NO. PARCEL NO.
OWNER NAME: ti�l t �� ! �11 i UAt /\ o VILLAGE: )
INSTALLATION DATE: BY:
ADDR/ESjS:� CERT. NO.
TANK INFORMATION
LOCATION OF TANK: / ( ,� /
CAPACITY TYPE '.J! t. AGE� FUEL/CHEM I CAL -rV a_ OIL
TESTING CERTIFICATION� ; C ] PASS C J FAIL DATE
LEAK DETECTION CJ�,7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C)(J YES C ] NO DATE TO BE REMOVED
// ��
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CUNSERVA i I ON C�4J� CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. IC ]C ]C ] DATE !�
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE- BACK OF THIS CARD
' r �
I
I
��� ��Z
9
-------------
THE COMMONWEALTH~6F MASSACHUSETTS
FIRE DISTRICT OF HYANNIS, MASS. `
tt F6RE DEPARTMENT
P FIRE •PREVEN W ION DIVISION
PERMIT FOR ;3TOR AGE OF FUEL OIL
John 14cGinn Nal2cm Caul 6 Oil
Name Name —
(Owner or Occupant) (Installer)
Address 25-Brook Road Address +—
Certif. Comp. 014526—R. LeClair—
Phone -Phone No. 715-1190
Phone No. --
(BURNER) (STORAGE)
NameRamey Whipple 1—
Type of Tank Staei Gy&
Sam Manufacturer Capacity =g gals. (or) Size
Model No. or Size E Location outsl.da
Type gun Mass, Approval No. 317__---___-- Permit Issue —
% of Carbon Dioxide — Draft _— Smoke Density
45
Stack Temp.-
—
Nozzle Size Fee 1C Richard R. %'X� G. J
Appl. Rec'd -10 13.138 - (Head a >
Issued By: _�Y Delangy By ----
t '
E
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: `J� � `� P.O. Box 534
CONTACT PERSON: e�,— ,� � A�f Hyannis, MA 02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in qua tities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES V NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be registered when stored_i -
ease put a check beside each product that you store:
y Antifreeze (for gasoline or coolant systems) Drain cleaners
V Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
✓ Motor oils/uu s- Road Salt (Halite)
Gasoline, Refrigerants
Diesel fuel, kerosene, #2 heatin Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
V Floor & furniture strippers Vet', st al Any other products with "Poison" labels
Metal polishes ✓ (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
✓ Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
� White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE OMPrrANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
� 0 unsatisfactory- 4.Manufacturers
COMPANY G"Q (see"Orders") 5.Retail Stores
1 6.Fuel Suppliers
ADDRESS r Class: 7.Miscellaneous
UANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERLACase lots Drums Above Tanks Underground
IN OUT IN OUTI IN OUT I#&gallons Age Test
Fuels:
Gasoline,
Diesel, Kerosene#2
Heavy Oils:
new motor oil (C) �
transmission/hydraulic*"`J
Synthetic Organics:
degreasers
Miscellaneous:
f �
DISPOSAURECI.AMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer Public
OOn-site OPrivate
3. Indoor Floor Drains YES NO l�
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO O ERS:
O Holding tank:MDC
Catch basin/Dry well ✓
O On-site system
5.Waste Transporter
i Destination Waste Product
C'_. • YES NO
2.
Person (s) Interviewed Inspector Date